As the world embraces the benefits and science surrounding cannabis based treatments, Tennessee patients look to our General Assembly with the hope that they, too, could utilize the medicinal properties in the chemicals in cannabis. Chairman Bryan Terry, MD (R-Murfreesboro) has filed The Clinical Cannabis Authorization and Research Act which provides such a pathway for Tennesseans. The Act would allow Tennesseans, under medical direction, to participate in a statewide clinical cannabis program where the foundation is formed by medical research and patient safety.

From its seeds, to the whole plant, to the chemicals extracted from the plant, cannabis has been utilized for medicinal purposes for centuries amongst various cultures. The World Health Organization referenced the evidence based medical research available on cannabis to state that cannabis does, in fact, have medicinal value, and recommended removing the restrictive classification of cannabis in order to promote more research and development of cannabis based treatments. Today, over two thirds of the states in America recognize the clinical value of cannabis and have exerted their 10th Amendment rights to help patients by providing them an alternative to the black market. Yet, Tennessee continues to languish in draconian policy by denying Tennesseans the ability to participate in research and development of cannabis based treatments, as well as prohibiting patients from their right to determine their own health care decisions. The Clinical Cannabis Authorization and Research Act looks to change all that.

“The World Health Organization, Federal judges, and a multitude of scientists, researchers, and medical professionals, to name a few, have opined about the medicinal value of the chemicals in cannabis,” stated Terry. “Unfortunately, outdated laws and unconstitutional treaties relying on erroneous information brought forth a prohibition of cannabis on all uses, including medical treatments and research. States are correcting this injustice across the nation and standing up for patients. It’s time Tennessee does so, as well.”

Tennessee is currently ranked third in the nation in an illicit marijuana market behind California and Kentucky. Much of the black market is generated by legitimate patients who, in looking for alternative treatments for things like chronic pain or other debilitating diseases, put their lives and livelihood at risk in search of relief. Other Tennessee patients, who could benefit, but do not go to the black market, either continue to suffer or look for relief in another state. The bill, as it is drafted, decriminalizes patients by offering a clinical pathway whereby patients can enroll in a clinical cannabis program that includes research and use of non-smokable cannabis based modalities under medical supervision. Once passed, having a safe alternative for patients should decrease the demand on the black market.

“Criminal justice reform is a big issue coming from the administration and on the national level. It is my belief that most elected officials do not want to criminalize patients, and this bill is a positive step towards reforming an archaic and cruel system that harms patients,” explained Terry. “If we, as a state, are going to be serious about criminal justice reform, we need to ensure that we are sending criminals to jail and not patients.”

The Clinical Cannabis Authorization and Research Act authorizes medical treatments in the form of oils, pills, breathing treatments, patches, creams, and known medical modalities. It explicitly prohibits recreational forms of cannabis including smoking, vaping, candies, or anything marketed towards children. Cannabis flower, which is the portion of the plant most known for being smokable, is only allowed for utilization in extracting the chemicals to make the medicines. The bill does not allow for the raw flower to be sold.

In addition to focusing on extract only medical modalities, the bill bases its safety and decriminalization regulations on current science and criminal statutes. Dosage and possession monthly limits of non-flower THC containing medical modalities mirror those of known medical standards and Tennessee statutes. One half ounce of cannabis flower on the black market may contain up to 2800 mg of THC which correlates to some off-label uses of lab made THC medicines. If purchased on the street, that amount of flower may last a patient a month, but it, also, carries the risk of a simple possession charge which is a Class A misdemeanor. In essence, the bill decriminalizes the possession of non-smokable, non-recreational cannabis based medicines for patients that enter the medical and research based program.

“Having spoken with many legislators including legislators from other states that have reformed medical cannabis, patients, medical providers, and researching the science, I’m convinced that we have developed a program that is beneficial for Tennessee patients and can pass our General Assembly,” concluded Terry.

HB 2454 is scheduled to be presented on Tuesday, March 3 in the Facilities, Licensure, and Regulations Committee.

A few months ago, it was discovered that Tennessee had accumulated $732 million in a Temporary Assistance for Needy Families(TANF) reserve fund available for utilization by the state in the form of a recoupment grant. These are federal funds that the state has available to use in a fiscally responsible manner to assist Tennesseans under certain circumstances. As the TANF process is in the form of recoupment, the state must first spend state funds within certain parameters under federal guidelines, then get reimbursed from the federal government.

As a background, Tennessee is eligible for $191 million in TANF recoupment funding each year. However, one must understand that in order for Tennessee to be eligible for the $191 million in TANF recoupment grant funding, the state must first spend a “Maintenance of Effort”(MOE) amount which is roughly $88 million in state funds. Once Tennessee has spent the MOE, additional state dollars spent on TANF may be recouped from the $191 million.

Unappropriated and non-recouped dollars from the annual allotment go into a reserve dedicated to Tennessee. Though our state has utilized TANF funds to assist needy Tennesseans, the unused portion has grown while Tennessee has been only using about a third of what is available. Over time, the reserve has built up to $732 million. The growth of the reserve led to the concern that the Tennessee Department of Human Services(TDHS) wasn’t utilizing the funds in an effective manner for Tennesseans.

With this concern in mind, Speaker Cameron Sexton appointed me to serve on a joint bipartisan and bicameral TANF Working Group to look into the issue. I was subsequently elected to chair the group. Goals set forth for the TANF Working Group included providing an action plan of recommendations for the utilization and distribution of the TANF funds in a fiscally responsible manner. Other goals included improving communication between TDHS, the administration and the legislature as it relates to feedback about the fiscal accountability and effectiveness of the program.

We began investigating what had transpired to bring about such a large reserve and had the Tennessee Comptroller of the Treasury office open an inquiry into the funding. Though on the surface the issue sounded fairly simple, as we began to investigate, we discovered multiple layers of complexity leading to a much more elaborate situation. What we have learned thus far is eye opening and an opportunity for Tennessee to make some positive changes.

First, Tennessee spent state funds above the MOE to the tune of $221 million dollars. It’s a common practice for states to spend above the MOE to bypass certain federal regulations or avoid fines. However, if the state meets all the regulations and thresholds, recouping the funds should be a priority. Unfortunately, it appears as if Tennessee did not recoup the overspent state dollars. At this point, it is unclear as to whether Tennessee can recoup the overspent state funds or if so, how much could be recouped. Our TANF Working Group has made this a priority step for DHS.

Second, as the economy improved, the TANF rolls dropped from around 61,000 Tennesseans to approximately 21,000. Though Tennessee increased the cash assistance benefit amount, more and more of the $191 million per year was not utilized. Adequate processes were not in place to ensure that all state dollars were recouped, and the process in place to explore fiscally responsible alternative uses for TANF funds was lacking. Additionally, functional communication to the General Assembly concerning the growth of the unused funds was missing. Instead, the reserve continued to accumulate to $732 million.

Legislators, constituents, and most importantly, taxpayers have a right to be irate and begs the question “If this is occurring in one department, what is going on in the others?” The good news is that our Working Group, which was bipartisan and bicameral, functioned in a productive manner. We investigated the issue and put forth initial recommendations for corrective action by DHS, which included recouping Tennessee taxpayer money, changing the culture and processes of the department, and improving communication between the department and the legislature.

One of our recommendations was to open a spring enrollment for 2Gen grant applications with a ceiling on the total grant amount, a priority list for utilization, and a process for reporting back to our group. The grant application process opened this week and can be accessed at the Tennessee Department of Human Services website.

Understanding that citizens often mistrust government is one of the reasons why I ran for office. I’ll continue doing my part by holding government accountable and working to ensure our tax dollars are utilized effectively.

Representative Bryan Terry, MD (R-Murfreesboro) earned the Award for Conservative Excellence, the top designation from the American Conservative Union(ACU) which was
published this past week. He has been invited to the Conservative Political Action Conference (CPAC) annual meeting to be held in National Harbor, Maryland to accept the award.

“Whether it is standing for the sanctity of life, our Second Amendment rights, our liberties, or sound fiscally conservative policy that enhances our economy, I’m honored to be recognized for
taking the concerns of District 48 to Nashville and producing positive results,” stated Rep. Terry.

The honor from the ACU follows previous recognition Rep. Terry received for his legislative
efforts by Club for Growth and the TN Legislative Report Card. With Club for Growth, Rep.
Terry’s score ranked second amongst all legislators including both House and Senate members.
Whereas, with TN Legislative Report Card, Rep. Terry was named a “model public servant”.

“I appreciate the awareness these various groups bring forth by recognizing the efforts, work,
and results many legislators put forward. Helping citizens be informed is of vital importance, but
in the end, what really matters is the opinion of the constituency,” explained Rep. Terry. “I’ll
continue to value the faith that our community places in me and I’ll keep working for the
betterment of our district and the state of Tennessee.”

Rep. Terry represents District 48 which is the eastern half of Rutherford County. He serves as
the Chairman of the House Health Committee and serves on the Insurance and Calendar and
Rules committees. He, also, serves on the TennCare, Mental Health and Substance Abuse,
Public Health, and Facilities, Licensure, and Regulations subcommittees.

The opioid crisis is a complex issue impacting Tennesseans of all demographics. Most recently, I opined on the issue in a three part series discussing the supply and demand of opioids including what steps have been taken at the state and where we need to go from here.

Please, follow the links to the articles and feel free to provide me any feedback at BryanTerry4TN@gmail.com

The Lee Administration has proposed an innovative, hybrid block grant solution to better address the unique needs of citizens who utilize TennCare for access to quality healthcare. The proposal is currently under a public comment period.

As a background, TennCare is a 12.7 billion dollar program where there is a 65/35 split in federal/state funding. The federal government provides 65% of the funds and the state supplies the other 35% via a required state match. If enrollment increases, the state must increase spending to meet the funding for additional patients unless the state/MCO’s decrease payment rates to providers and hospitals.

Of note, MediCare often doesn’t pay providers or hospitals the amount necessary to even meet the cost of providing the care to those patients. TennCare, which is Medicaid, pays providers and hospitals significantly less than Medicare, sometimes even 40-60% less. TennCare’s motto promotes high quality, cost efficient care. Providers and hospitals provide TennCare patients the same care as privately insured patients, but, often, at a financial loss. It is because of the low reimbursements from TennCare that the third leg of the health care stool-access- suffers.

In order for providers to keep their medical practices open, they must have a positive payer mix. TennCare, for the most part, does not improve a provider’s payer mix; thus, expanding TennCare in any traditional sense isn’t going to improve a payer mix nor improve access. In order to stay afloat, many providers have to limit the number of TennCare patients that they can or will see. More patients without an improvement in reimbursement isn’t going to change the number of TennCare patients that a provider can see.

While the TennCare program is 12.7 billion dollars, Tennessee is currently 6.8 BILLION under our waiver cap. That means that TennCare saves the government 6.8 billion dollars a year(roughly 4.4 federal and 2.4 state). The state receives “credit” for about 1/4 of that when they look at our waiver. So, one way of looking at TennCare’s efficiency is that the state saves federal and state taxpayers 6.8 billion dollars a year. The other way of looking at it is that TennCare has been underpaying hospitals and providers significantly since its inception-roughly $54 billion alone over the last decade.

The hybrid block grant proposal aims to leverage Tennessee’s efficiency into receiving a portion of the saved federal dollars via a mechanism called “shared savings”. If Tennessee saves the federal government two billion, then we should receive half of that in the form of funding without burdening Tennessee taxpayers with an additional match of 35%. The hybrid proposal, also, has safeguards for Tennessee in that if our enrollment numbers increase, our block grant will increase, as well. Additionally, it includes a yearly increase to keep up with inflation or growth.

The current federal system of Medicaid rewards states that overtax and overgrow their Medicaid system while punishing states like Tennessee that are efficient. A proposal that rewards fiscal soundness and conservativeness should be promoted, not punished. In a world where government waste and taxpayer abuse runs rampant, a proposal that protects taxpayers while ensuring constituent services are protected should be applauded.

Of course, the devil is in the details. If Tennessee is granted the funds, but expands services or enrollees without addressing the payment disparity, especially amongst rural providers, the block grant will not be addressing the third leg of health care which is access. Any proposal that does not look to improve payments to hospitals and providers who take a disproportionate number of TennCare patients, particularly in rural areas, will be missing an opportunity to better serve Tennesseans.

That being said, I find it ironic that most of those who advance the idea of Medicaid expansion never look to address the access problem current TennCare recipients have. They just speak about expanding the rolls without regards to the stress on the system due to the payment disparities that lead to poor payer mixes and restricted available appointments. Expanding rolls without first addressing the underlying problems does not benefit current recipients nor does it protect taxpayers.

A hybrid block grant, if constructed the correct way, has the potential to help address the payment problems that plague rural providers while, also, helping improve access for current recipients. If Tennessee can accomplish those goals while protecting Tennessee taxpayers, shouldn’t that option be seriously considered?

I’ve attached an article that discusses the block grant proposal, as well as some of the stakeholder’s comments.

“The Lee administration argues TennCare’s managed care approach has already led to an estimated $2 billion in annual cost savings for Uncle Sam over what a traditional fee-for-service Medicaid program would cost the federal government.

So Lee hopes to negotiate a 50/50 split on those and additional cost savings in which the state could reap as much as $1 billion, which Lee hopes to plow into improving rural health care and other initiatives.”

Much has been opined about the opioid crisis including what caused it, whose fault is it, and what can be done about it. Across the country, opioid related overdose deaths deceased four percent. Yet, Tennessee’s rate of overdoses continues to climb despite measures taken at the state level.

While many of the measures I have advocated for have passed, some of the more vital measures have not. The opioid crisis is a multifaceted problem with many intertwined and complicated parts. Unfortunately, many have a myopic view of the issue while others are just looking to do something for the sake of claiming they did something. Add in that many are advocating for seemingly unrelated issues, and it is easier to understand why this epidemic is a difficult problem to solve.

Understanding the supply and demand dynamics of the opioid crisis can help us find solutions, but it requires those looking for solutions to have open minds and a willingness to step away from failed strategies. To appreciate the supply and demand dynamics of opioids, one must first understand that there is both a legitimate and illicit demand for and supply of opioids.

Legitimate demand comes in the form of patients. Whether it is an acute injury like a broken bone, a perioperative need either before, during, or after surgery, or chronic pain associated with conditions like cancer, failed surgery, or a nerve injury, there is a consistent and endless market for the use of opioids. And while there are new drugs reaching the market all the time, until one becomes as effective in alleviating pain while minimizing side effects, the demand for opioids will continue.

Ironically, another legitimate demand from patients is that from one that is addicted to opioids. Patients who are addicted to heroin, fentanyl, or another opioid often undergo treatment in which methadone — another opioid — is often substituted. Buprenorphine, an agonist that produces opioid effects and an antagonist that blocks certain opioid effects is frequently used for treatment as well.

Illicit demand comes in several forms. Obviously, the most common cases involve those who are addicted to opioids. The process usually begins with initial use that may lead to tolerance, then to dependency and finally addiction. It may start as a legitimate patient who progresses to addiction or addiction that develops via recreational usage. Regardless of the route taken, addiction drives much of the illicit demand.

Another form of illicit demand includes those looking for a recreational use. Whether it is in the form of a party or one looking for a route of escape from reality or a psychological, physical, or emotional trauma, there are those who turn to opioids, which increases demand for the deadly drugs.

Perhaps, one of the more unfortunate illicit demands for opioids is from legitimate patients who have a physical need, but are under treated or mistreated by the system. Some patients in chronic pain or with cancer pain may look to alcohol, marijuana, or street opioids in order to function normally.

As physicians and as legislators, treating patients with a legitimate need for an opioid while preventing or decreasing the illicit demand is where many efforts need to be addressed. Decreasing the risk for patients to get on the on ramp to addiction is vitally important; it is just as important to prevent those who have gotten off the addiction highway from getting back on by ensuring there is proper addiction treatment available.

The supply side also has a legitimate and an illicit aspect. Legitimate supply comes in the form of a prescription from a medical related need by a patient. Opioids are supplied via a doctor, pharmacy, or hospital. Real patients with legitimate needs delivered in a safe, and effective manner drives much of the supply side of opioids.

Unfortunately, the legitimate supply side has been contaminated by the government, big pharma, and unscrupulous providers leading to an oversupply of unnecessary opioids into the marketplace. The government, by making pain the fifth vital sign, tying Medicare payments to patient satisfaction surveys, and instituting laws like the Intractable Pain Treatment Act didn’t just incentivize prescribing opioids, they mandated it. Big Pharma pushed controlled release opioids like OxyContin as a safer alternative, and many providers abused the new medical landscape placing pain profit over patients.

The illicit supply side of opioids involves two main sources: diversion or the selling or distribution of FDA approved opioids, as well as the trafficking of illicitly manufactured opioids. Unused prescription opioids and addiction treatment opioids are being sold on our streets or used in a recreational setting, and it has been a major concern in their illicit supply.

While appropriate and inappropriate uses of FDA approved opioids are a major concern, especially when mixed with other drugs, it is the trafficking of illicit opioids like heroin, fentanyl, and carfentanil that should scare people. As an anesthesiologist, I treat patients with fentanyl almost every day. For its indicated use and under the right medical direction, it is a valuable tool. However, when traffickers can possess millions of lethal doses and push it into our communities, it becomes a major health concern. To make matters worse, many of these illicit opioids are being manufactured in China and wind up in our communities through Mexico.

As one can see, the supply and demand side of the opioid equation is quite intricate. If we truly want to be able to address this complex issue, focusing on one aspect while avoiding or neglecting the others will ultimately lead to failure. It is going to take a multifaceted approach with a willingness to attack all sides of the supply and demand equation to get Tennessee on the pathway to a better tomorrow.

Bryan Terry, MD (R-Murfreesboro) is the Chairman of the Tennessee House Health Committee. This is Part One of a two part series on Opioids: Supply and Demand.

Folks, I wanted to give the community an update on what has been going on with the DMV and ask for community input as we move into next year’s session. As I have been investigating the issues, a couple of stories have come about that highlight some of the issues at our driver’s service centers across the state.

As many know, we have a driver’s service center(DMV) located off Middle Tennessee Blvd. They provide driving permits, driver’s licenses, road testing, renewals, handgun permits, and now they have Real ID. We, also, have three renewal kiosks located in Rutherford County.

Nobody enjoys going to the DMV. Nobody wants to wait. Nobody who values their health points to the DMV and demands a DMV style government run health care system. It is an essential government service that everyone points to as a prime example of government inefficiency. Despite upgrades or changes, it always seems as if the system is still behind.

Over the past few weeks, I’ve been investigating some issues that have cropped up. Ironically, the economy is booming and our labor market has gotten tight. For employees, it is great in that wages have risen, and employees are in high demand in the workplace. For those hiring, including the government, it means one has to look for solutions in order to offer a productive and efficient service.

Between emails, phones calls and meetings with the Department of Safety, Governor Lee’s office, our Speaker and Finance chair, and leadership, I have been looking for some solutions that could benefit our citizens. As I’ve described my four step process on issues before, I wanted to explain my process on this issue.

PREMISE OR PROBLEM

Our DMV has been experiencing extended delays for services, including in the office and road test services. While this premise or problem seems to be the standard operating procedure for a DMV, we have seen a recent worsening of this problem.

A few years ago, I looked into the issue. What I discovered was that the state average wait for a road test was 12 days while Rutherford County was around 18 days. Some options were floated, but the direction the Department of Safety wanted to take was to offload services from the DMV site either via kiosks or having counties oversee some of the services.

Rutherford County did not participate in absorbing some of these services. With a tight county budget and personnel restrictions, I certainly understand the decision. (As an aside, Lisa Duke Crowell is doing an admirable job and is willing to work for solutions. She has the interest of our constituents and taxpayers in mind.).

In the end, the Department of Safety placed three kiosks in Rutherford County. These kiosks help with renewals and are located at Middle Tennessee State University, the Murfreesboro Driver Services Center, and Rutherford County Clerk (Smyrna).

Currently, there are three acute problems occurring at our DMV. First, is personnel. We are supposed to have 8.5 full time equivalent employees at the center. Unfortunately, we are down 3 employees due to vacancies. The Dept. Of Safety has increased their salaries and has hired 3 people to fill the vacancies, but they haven’t started yet. Additionally, I have been told that our DMV recently had a person on vacation, one out for surgery, and one sick. They were down to 2.5 employees which backed things up considerably.

In today’s job market, it is difficult to attract employees to work in a DMV. It is a thankless job that has high turnover. Ironically, as I discuss turnover and vacancy issues, one of the individuals with the department that supplied me with information is no longer there.

Secondly, with Real ID coming into fruition, we have had an influx of people needing new IDs at the DMV. There are kiosks in the county to offload renewals, but that doesn’t help with new or real ID’s. Thirdly, gun permits have increased, as well.

We aren’t the only center having issues. There are 43 other centers in Tennessee like our center in Murfreesboro. Statewide, there are 29 vacancies. In addition, statewide there is a road testing average wait time of 11 days. Unfortunately, Rutherford County seems to be hit exceedingly hard. We have 10% of the vacancies and our road testing wait time is 28 days. Only the East Shelby County Driver’s Center has a longer wait at 29 days.

GOALS

Obviously, the goal should be to provide an efficient public service to the community in a cost efficient manner.

OPTIONS

Self-governance is the cornerstone of our republic. So, I am more than open to listening to any options that may be presented. Please, contact my office if you have any. That being said, I’ve been having discussions on three basic options. Understand that the Department of Safety has given raises to employees, but that still hasn’t resolved the issue.

First, the Department of Safety is continuing to look at offloading services from the main office. They are partnering with County Clerk Office’s to have county government provide some of the services. Many counties have joined in the partnership. Rutherford County has not, as of yet. Secondly, adding more kiosks may allow for decreasing demand at the service center.

Third, with high turnover and need to cover vacancies, vacations, and sick leave, starting a float pool to either work in the office or provide road testing is an option that I have discussed with the Department of Safety and the Lee Administration.

FEASIBILITY

Without significant financial outlay from the state to Rutherford County, it will be difficult for our county to participate in a partnership. With a tight county budget, personnel restrictions, and on the heels of a county tax increase, asking the county to foot the bill doesn’t seem feasible.

With a greater than 600 million dollar surplus, Tennessee should have significant non-recurring and recurring funds. Non-recurring funds could help with setting up more kiosks. Recurring funds could help with setting up and running a float pool.

CONCLUSION

The Department of Safety will be presenting their budget requests to the Governor soon. For our citizens, these services are a priority, and I’m pushing for them to address the concerns of our growing county.

(Nashville, Tenn.) — Throughout his time serving in the Tennessee General Assembly, State Representative Bryan Terry (R-Murfreesboro) has fought to make Tennessee an attractive destination for businesses and for families.

U.S. News recently ranked Tennessee No.1 in their report for Best States for Fiscal Stability while Business Facilities Magazine recognized Tennessee as having the best business climate.

“Our conservative, job friendly policies are helping Tennessee attract and grow businesses. We’re seeing businesses move to Tennessee from other states while also seeing Tennesseans open new businesses,” stated Terry. “Business leaders are showing confidence in Tennessee and it is reflected in our strong economy.”

With low unemployment rates and a strong business climate, Tennessee’s average median household income is growing at the second fastest rate in the entire southeast. The average private business hourly wage has grown in Tennessee and is hovering around $24 per hour without the regulatory endangerment of a $15 an hour minimum wage mandate.

“Tennessee is rising to the task of better jobs and wages without resorting to added regulatory burdens and legislative mandates that are counterproductive. However, this is just one piece of the puzzle to improve the quality of life for Tennesseans,” stated Terry. “Families and businesses prioritize various attributes of a community or state when looking to grow a business or raise a family. I am working diligently with my colleagues to address these other elements like health, safety, and quality education.”

While not often cited as the main deciding factor for family and business location, access to recreation and leisure activities often plays a pivotal role. Industries such as leisure, hospitality, and tourism, tend to thrive in healthy economic areas like Tennessee. The tourism industry — which currently employs 189,757 citizens and accounts for 6 percent of all jobs — generated over $1.8 billion in state and local revenue alone last year. That is a $50 million increase for the state over the previous year.

“Our economy is firing on all cylinders right now, and new companies are relocating to Tennessee every day. Clearly, Tennessee tourism and the hospitality industry are key components to our overall success, and my colleagues and I will continue to support those employed through these and all of our industries. Under Republican leadership, Tennessee will remain the best place in the entire nation to live, work, raise a family, and retire,” Terry concluded.

Bryan Terry, MD serves as Chairman of the House Health Committee. He is also a member of the House Insurance and the House Calendar & Rules Committees, as well as the Facilities, Licensure & Regulations, Mental Health, Public Health, and TennCare Subcommittees. Terry lives in Murfreesboro and represents Tennessee House District 48, which includes a portion of Rutherford County. He can be reached by email at: Rep.Bryan.Terry@capitol.tn.gov or by calling (615) 741-2180.

NASHVILLE, JULY 8, 2019– Representative Bryan Terry (R-Murfreesboro) recently sent letters to the Centers for Medicare & Medicaid Services (CMS) on behalf of District 48 and the Tennessee House Health Committee for support of a new proposed federal rule that would help improve the financial situation of Tennessee hospitals. The rule would adjust the formula for calculating the Medicare Area Wage Index (AWI) which would improve payments to Tennessee hospitals and help stabilize the health care market.

“Because Medicare payments are predicated on the Area Wage Index and the AWI for Tennessee is low, our hospitals, especially our rural hospitals and those located in East Tennessee, are placed at a significant financial disadvantage compared to other states,” explained Terry. “While medical equipment, supplies, and medications have continued to climb, Tennessee’s AWI has not. Hopefully, CMS will fix this disparity.”

Currently, every county in the State of Tennessee falls below the area wage index. This places Tennessee at a rank that is near the bottom of the reimbursement ranks in the country and has created a financial problem for hospitals in Tennessee. The relief CMS has proposed in this rule will help keep more Tennessee hospitals from shutting down, and it will help keep healthcare access open for our citizens.

As Chairman of the Health Committee, Terry worked with the Tennessee Hospital Association, members of his committee, and other groups to address this problem. In his letters, he pointed out that the structural make-up of AWI created a cycle that has led to the downfall of Tennessee’s reimbursement rate over the last 15 years. He emphasized that the proposed rule by CMS, CMS- 1716-P, would allow a beneficial plan to resolve the wage index disparities for hospitals with a wage index value below the 25th percentile, and would check the abuses of the “rural floor” calculation seen in other states.

“Medicare often doesn’t even pay enough to cover the costs to provide a service. TennCare often pays significantly less than Medicare. This problem has to be addressed if we want to recruit doctors and services that will keep our hospitals afloat,” stated Terry. “While this rule change won’t solve every problem in health care, it is a necessary step.”

In addition to addressing the AWI, Terry has been actively working on legislation within the House Republican CARE Plan which is aimed at decreasing costs and improving consumer driven care. He has, also, been working to increase efficiency with TennCare while looking to help Tennessee take advantage of the State Relief and Empowerment Waivers offered by the Trump Administration.

Many high priority topics were heard in the first year of the 111th General Assembly. I was privileged to take part in sponsoring and supporting several initiatives that will make Tennessee even better.

Healthcare –

Katie Beckett Waivers (HB 498) – This allows children with severe medical needs to receive in home care and services that they need, even if their parents’ annual income exceeds the income cap. Some families have had to divorce in order for one of the parents to qualify for TennCare in order to get help for their child. As part of the TennCare committee, I helped to form and sponsor this legislation.

Pharmacy Benefits Managers (HB 786) – PBMs, the middlemen often responsible for increased drug pricing and unfair practices against pharmacies, will now have guardrails around their actions due to the regulations passed in House Bill 786, which I co-sponsored. Additionally, I passed a budget appropriations amendment that will allow the state to implement best practice guidelines for PBMs.

Opioids (HB 705, HB 942) – Illicit fentanyl and carfentanil are opioids that are more potent than heroin, but carried lesser penalties. I co-sponsored both of these bills that increased penalties for the trafficking of these opioids.

Insurance (HB 1126 & HB 419) – I supported insurance legislation that will allow for health care policies amongst a collaboration of small businesses. In addition, I supported the Right to Shop Act which will require health insurance carriers to create incentive programs for policy holders who have met their deductible to look for healthcare providers that provide quality healthcare services at a cost lower than the average price.

Local –

Firefighters (HB 316 & HB 123) – We were able to provide better care and service to our Tennessee firefighters with a bill which will provide healthcare compensation to firefighters who have been diagnosed with cancer as a result of their work in the line of duty. Secondly, my Arson Investigator bill will extend police powers and the ability to make arrests related to arson investigation to county fire investigators. This will allow the Rutherford County Fire Department to perform their investigative duties in a much more efficient and effective manner.

Sheriffs’ Departments (HB 643) – Thanks to overwhelming support for the mental health transportation bill, Sheriffs’ departments across the state will have an alternative for transportation of mental health patients. This initiative will protect our officers and our patients.

Voter Convenience (HB 1077) – I previously passed a voter convenience pilot program for a Rutherford County. The program was an overwhelming success, and House Bill 1077 makes sure Rutherford County will be able to continue with convenient voting centers for our elections.

MTSU Funding – I was glad to support Governor Lee’s 2019 budget, which included nearly $35 million in funding for the MTSU Concrete Industry Management program.

Abortion –

Heartbeat Bill (HB 77) – I stood for Pro-Life legislation when the House of Representatives passed the Heartbeat Bill which would prohibit abortions after a fetal heartbeat was detected, unless there were concerns for the health of the mother. Unfortunately, the Senate deferred action until 2020.

Complications of Abortion Reporting Bill (HB 711) – With the passing of my Complications Reporting Bill, Planned Parenthood will be exposed and held accountable for the complications encountered during abortion procedures that Tennessee tax dollars have to pay to fix.

Illegal Immigration –

State Dollars – I stood with the other conservative members in the fight against illegal immigration. I helped to ensure that illegal immigrants would not be able receive state benefits,

E-Verify (HB 1239) – I also supported a bill that requires that employers with 25 or more employees enroll in an electronic verification program to confirm the work authorization status of their employees. In the previous session, I helped reduce the requirement from 100 to 50 employees. This bill will reduce that number further. Unfortunately, the Senate deferred action until 2020.

Education –

Budget Funding – The General Assembly secured $168 million in new funding for Tennessee Public Education, including increased teacher pay, more school resource officers, expanded vocational education, and increased BEP funding.

MTSU Scholarships – The 2019 budget also included $750,000 in financial aid for scholarships for students in the joint MTSU/Meharry medical program.

Teacher Reward Bill (HB 632) – I sponsored and passed a bill that provides a reward of five additional professional development points (PDP) to teachers working in Priority or Focus list schools. Teachers are required to earn 60 PDP’s for their license every 6 years. The bill will help those teachers who work in difficult educational environments.

Teacher Evaluations (HB 928) – I stood with Governor Lee in his initiative to update the Tennessee teacher evaluation process. While I recognize that further protections are necessary, the bill is a step in the right direction. I will continue to fight to protect our teachers in the future.

Taxes & Employment –

The General Assembly unanimously passed a $38.5 billion budget. The budget included an addition of $225 million to the state’s rainy day fund, while eliminating the professional privilege tax for 15 professions, the amusement tax on gyms and fitness centers, and the tax on ammunition.

Tennessee’s economy is prospering. Tennessee has record low unemployment at 3.2%, businesses are moving to Tennessee every day, and the General Assembly secured $222 million to continue to bring high paying jobs to Tennessee.